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Calls to the British Columbia Drug and Poison Information
Centre on the cusp of cannabis legalization
Tissa Rahim June 12, 2019
Background
• Cannabis legalized October 17, 2018 sale of cannabis became legal sale of edible cannabis products remained illegal
• US poison centres reported increased numbers of calls especially children consuming edible products
• We queried whether similar increases occurred in BC immediately prior to and following cannabis legalization
Calls taken and recorded at the BC Drug and Poison Information Centre (DPIC)
1. Manage case: • Refer • Manage at home • Provide information health care
providers
poison centre
public
poison info specialist records call information in call database
coded fields case history notes
health-link
Call records at BC DPIC
Identification of cannabis exposure calls, 2013 – 2018
Call records at BC DPIC Coded as cannabis Not coded as cannabis but
evidence via a free text search
Included if evidence of cannabis in the case history notes Excluded: 1. Information-only 2.Only evidence of cannabis was a toxicology screen 3.Animals 4.Miscoded as cannabis 5.Outside BC
2318
Fields assessed for data quality and retained as is
Age Substance Patient flow (case management site)
Unit of age Substance formulation Hospital flow (management of cases referred to hospital)
Unknown age notes Substance quantity Outcome Sex Substance quantity unit Exposure site Exposure date Therapy Caller type Call date Treatment Reason for exposure Symptoms
Fields accessed, created and analyzed
Fields verified and expanded through information in case history notes Exposure to substances in addition to cannabis: alcohol, illicit drugs and harm substances Exposure Site Route of exposure Caller type
Fields accessed, created and analyzed
New fields created from case history notes Purpose of cannabis use Motivation for call to the poison centre Source of cannabis Past history of cannabis use Symptoms for which there is no code
Fields accessed, created and analyzed
Cannabis exposure calls, 2013-2018 % of all exposure calls to DPIC
0.9 1.1
1.1
1.4
1.7
2.3
Cannabis legalized
Liberals elected
Task Force recommendations
released Bill C-45 passed
0
100
200
300
400
500
600
700
2013 2014 2015 2016 2017 2018
Calls
All calls that year Sept-Oct 16 Oct 17-Dec 31
10 19 12 19 13
21 12 26
12
26 14
25
Cannabis exposure calls, 2013-2018, with percent received Sept-Oct 16, and Oct 17-Dec
Time period Time block % of time in period
% of calls in period
Ratio
Pre-election of Liberal party
Jan 2013- Nov 3 2015 48 33 0.69
Election up to Task Force
recommendations
Nov 4 2015-Dec 12 2016 19 18 0.95
Task Force recommendations
up to Bill C-45
Dec 13 2016-May 31 2018 25 32 1.28
Bill C-45 up to legalization
June 1 2018-Oct 16 2018 6 11 1.83
Post-legalization Oct 17 2018-Dec 2018 2 7 3.50
Cannabis exposure calls by age, 2013-2018
241 275 302 390 466 644
4
32
34 10 20
3
23
42 10
22
7
23
38
15
18
5
23
36
16
19
7
16
40
13
24
10
16
39
15
21
Total
Cannabis exposure calls by gender, 2013-2018
45
54
2
43
52
4
42
56
2
42
57
1
49
50
1
49
50
1
241 275 302 390 466 644 Total
BC Health Authority
Northern Interior Fraser Vancouver Island Vancouver Coastal
Cannabis exposure calls by Health Authority, 2013-2018
0
5
10
15
2013 2014 2015 2016 2017 2018
Rate
per
100
,000
Fraser
0
5
10
15
2013 2014 2015 2016 2017 2018
Rate
per
100
,000
Interior
0
5
10
15
20
2013 2014 2015 2016 2017 2018
Rate
per
100
,000
Vancouver Coastal
0
5
10
15
20
2013 2014 2015 2016 2017 2018
Rate
per
100
,000
Vancouver Island
0
5
10
15
2013 2014 2015 2016 2017 2018
Rate
per
100
,000
Northern % change in relative
proportion, 2013-2018
4
-5
4
6
-12
Cannabis exposure calls by exposure source, 2013-2018
11
6
4 0.4
13
0.4
1
8
6
18
1
4
7
5
13
1
4
7
4
241 273 299 383 453 629
11
1
3 0.2
8
1 1
12
2
2 1
8
0.2 1
Source not recorded in 73% of cases
Total
(where noted)
43
24 9
24
37
31
11
21
42
25
15
18
41
20
19
20
41
32
17
10
33
38
21
8
241 273 299 383 453 629
Cannabis exposure calls by vehicle, 2013-2018
Total
Smoked Exposure to cannabis via inhalation
Edible Exposure to food/beverage products containing cannabinoids
Medication Exposure to pills, tablets, capsules, concentrates, nabilone (synthetic cannabinoid), tinctures, oils, etc.
What smoked products were used?
% 2013 2014 2015 2016 2017 2018 Joint/roach 14 13 18 11 12 12 “Second-hand” 7 6 6 4 2 0 Vape 0 0 0 1 0 3 Bong/pipe 5 3 4 2 3 5 Synthetic 0 1 0 0 0 1 Shatter/dab 0 3 4 3 4 4 Popper 0 0 0 1 1 1 Hot-knife 0 0 0 1 1 0 Unspecified 75 74 67 78 79 74
Decreased Increased
What smoked products did teens 13-18 years old use, 2013-2018?
What edibles were used?
*includes joints, vaporizer liquid, shatter
% 2013 2014 2015 2016 2017 2018 Brownie 47 36 28 27 14 13 Cookie 41 53 30 38 29 24 Candy/gummy 0 1 8 12 17 29 Chocolate 2 2 4 6 9 6 Edible oil/butter 0 1 3 0 7 1 Tea/drink 3 1 4 5 1 0 Bread/square/loaf 0 0 3 1 2 1 Muffin 2 5 3 0 1 1 Cake 2 4 4 0 2 1 Other (inappropriate)* 2 6 12 8 3 4 Unspecified 2 2 1 3 14 20
Decreased Increased
What edibles were children 12 years and younger exposed to?
*includes joints, vaporizer liquid, shatter
0
20
40
60
80
100
2013 2014 2015 2016 2017 2018
Candy/gummy Other edible
2013-2018
What “medical cannabis” products were used? % 2013 2014 2015 2016 2017 2018 Nabilone 64 43 29 20 19 4 Capsule/tablet/pill/lozenge 5 13 22 34 24 31 Honey Tears 0 0 0 1 0 1 THC/CBD combination 0 0 0 4 1 8 Extract/tincture 9 3 2 0 8 5 Concentrate/liquid 5 3 7 1 3 2 Oil 5 27 22 28 37 38 Phoenix Tears 9 0 5 3 3 2 Spray 0 3 0 3 0 3 Dermal 0 0 0 3 0 3 Other/unspecified 5 7 12 3 6 3
Decreased Increased
What medical cannabis products did seniors use?
0102030405060708090
100
2013 2014 2015 2016 2017 2018
Nabilone Oil Other medication
2013-2018
Cannabis exposure calls by user familiarity, 2013-2018
241 273 299 383 453 629
8
27
14
30
17
41
16
46
18
37
18
39
User type not recorded in 47% of cases
Total
(where noted)
Clinical outcome of children 12 years and younger exposed to cannabis, 2013-2018
9 8 21 21 33 63
11 22 11 56
13 25 63
5 19
24 14
24 14
19
33
14
29
5
6
27
24
6 33
3
6
19
37
16
21
2
Total
4 31
32
1
9
22
2
36
41
14
8
7
31
34
1
19
7
3
36
32
3
13
13
1 30
47
1
15 5
2
21
50
1
17
8
77 64 68 88 103 73 Total
Clinical outcome of teens 13-18 years exposed to cannabis, 2013-2018
Clinical outcome of adults 19-49 years exposed to cannabis, 2013-2018
5 33
27
5 26 5
82 116 115 142 248 188
5
34
41
3 12 4
3 39
36
1 16 5
4
39
35
20
2
3 33
51
1 10 2
2
32
50
1 12
2
Total
29 55 52 74 152 105
3 21 41
7 21 7
36
44 2
15 4
38
42 15 4
43
35
20 1
2 35
53
9 1
2 28
57
11 3
Calls where cannabis was the sole exposure substance
Total
Clinical outcome of adults 19-49 years exposed to cannabis, 2013-2018
5 33
27
5 26 5
82 116 115 142 248 188
5
34
41
3 12 4
3 39
36
1 16 5
4
39
35
20
2
3 33
51
1 10 2
2
32
50
1 12
2
Total 29 55 52 74 152 105
3 21 41 7 21 7
36 44 2
15 4
38 42 15 4
43
35
20 1
2 35
53
9 1
2 28
57
11 3
Calls where cannabis was the sole exposure substance
Total
Clinical outcome of older adults 50 years and older exposed to cannabis, 2013-2018
24 27 44 63 96 61
4 33
38
21 4
4 33
56
4 4
2
36
39
14 9
3
41
40
14 2
2
39
41
2 15 2
31
49
18
2
Total
Looking at cannabis calls to BC DPIC from 2013-2018 we found: • Calls to DPIC tripled between 2013 and 2018
• Proportion of calls about young children (0-12 years) and women increased from 4 to 10% and from 45 to 49%, respectively
• Proportion of calls from Vancouver Island increased the most (from 15 to 21%)
Summary
Looking at cannabis calls to BC DPIC from 2013-2018 we found:
Summary continued
• Proportion of calls about edibles and medications increased • Edibles (24 to 38%); especially candies • Medications (9 to 21%): especially oils, capsules, THC/CBD
combinations
• Increasingly obtained from stores/online (0 to 9%)
• When taken with other substances the proportion with more severe clinical outcome was higher (for adults)
Interpretation
• Illegal products purchased from stores/online • Adverse effects due to unregulated products
• Consistent increase in cannabis calls; more rapid starting in 2015 • Seasonal with end-of-year peaks starting in 2015
• Young children accidentally exposed to edibles
• When used alone, cannabis exposures most often resulted in minor medical outcomes for adults
Potential reasons for changes in cannabis calls
Interpretation continued
- Likely more a result of continued normalization rather than key dates
- Appearance of new cannabis products
- Legalization was also co-occurring in US states - Dispensaries popping up during this time period - Minimal police enforcement - Increased acceptance of legalization - BC has long been “cannabis friendly”
The staff at DPIC Dennis Leong Debra Kent Victoria Wan Roy Purssell Emma Cumming Adrian Grehan Sarah Henderson Tom Kosatsky
Thank you and acknowledgments